Perspective:

The following are key points from a review article on guidelines on driving for those with arrhythmia and implantable cardioverter-defibrillators (ICDs):

1. Motor vehicle accidents secondary to incapacity caused by arrhythmias are infrequent, but can have deadly consequences. A single study suggested that the commonest cause for incapacity resulting in accidents was epilepsy, with heart conditions accounting for only 8%.

2. Despite the pathophysiologic basis for an increased frequency of arrhythmias during driving, there is a lack of convincing causal evidence that links the activity of driving with the generation of arrhythmia.

3. International guidelines may aid in deciding whether a patient with an arrhythmic condition is safe to drive. As would be expected, the guidelines impose more stringent criteria for relicensing for Class 2 commercial drivers (who pose a greater risk to other individuals) versus Class 1 private drivers.

4. The presence of an ICD for any indication should restrict a patient from holding a Class 2 driving license.

5. The likelihood of an ICD discharge in those who received the therapy for primary prevention is low enough (estimated to be <0.15%) to justify the 4 weeks of driving restriction recommended in the international guidelines following implant.

6. Those receiving either an inappropriate or appropriate therapy (shock or symptomatic anti-tachycardia pacing) from an ICD should cease driving for 6 months.

7. A 6-month driving restriction is recommended for Class 1 drivers following ICD implant for secondary prevention.

8. In the United States, Class 1 and 2 drivers should be restricted from driving for 3 and 6 months, respectively, following therapy for nonsustained ventricular tachycardia (VT). A period of 6 months of restricted driving is recommended for Class 1 drivers following therapy for VT (3 months for idiopathic VT without symptoms). A total restriction is recommended for Class 2 divers who experience VT (unless VT is both idiopathic and asymptomatic).

9. Class I drivers should be restricted from driving if they experience syncope secondary to bradyarrhythmias. No restriction is necessary for asymptomatic bradyarrhythmias.

10. Class I drivers may resume driving after 1 month of control of symptoms attributed to supraventricular arrhythmia.